Home Health Aides: In Demand, Yet Paid Little

Home health aide trainees Marisol Maldonaldo (center) and Nancy Brown (right), shown here with assistant instructor Miguelina Sosa, are studying to join one of the nation's fastest growing yet also worst paid sectors of the workforce.

Jennifer LuddenNPR

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Originally published on October 17, 2012 3:29 pm

The home care workforce — some 2.5 million strong — is one of the nation's fastest growing yet also worst paid. Turnover is high, and with a potential labor shortage looming as the baby boomers age, there are efforts to attract more people to the job.

One such effort plays out in a large, sunny room in a Bronx high-rise, where Cooperative Home Care Associates holds an extensive, monthlong training program. On a recent day, two dozen women paired off at rows of hospital beds. As instructors coached them, they took turns lifting each other in a mechanical sling, or gently stretching each other's limbs, as is commonly done for stroke patients.

Such training distinguishes Cooperative Home Care Associates, along with the vision of the agency's president, Michael Elsas.

"We think that our workers are ready to use some of the newer technology," he says, "the smartphone type of technology."

Elsas says home aides could monitor and record things, such as changes in a patient's skin color. This could cut down on doctor's visits, perhaps even hospitalizations, "which would lower the cost of health care, have a dramatic effect on the cost of health care," he says.

And Elsas hopes that would have a dramatic effect on how much society values home health workers.

Right now, many get no training at all. There's little path to advancement. And with a median wage less than $10 an hour, it's hard to call this a career. Trainee Mary Miranda came to Cooperative Home Care Associates after a year's unemployment and will earn even less than she did in retail.

"It's not much," she shrugs on her lunch break. "But it's a stepping stone. Sometimes you gotta just take it as it goes and make the best out of everything."

Advocates say one big problem is a decades-old law that exempts home care workers from federal minimum wage and overtime, likening them to babysitters. Elsas believes this drags down wages across the field.

A year ago, President Obama proposed a rule to end that exemption, but it's yet to be finalized, so the lobbying goes on.

A few weeks ago, several dozen home aides from across the country came to Washington, D.C., for an advocacy day put on by the Direct Care Alliance. In matching royal blue T-shirts, they fanned out across Capitol Hill to make their case for better pay.

"When I'm in home care, I'm a doctor, I'm a nurse, I'm a cook, I'm a dietician," says Tracy Dudzinski, who traveled from Wisconsin. "You name it, we do it."

Over 16 years, Dudzinski says she's seen her duties grow more complex, as people live longer and hospitals release patients sooner after surgery.

"We have to watch for if they're having a reaction to medication," she says. "Sometimes we're doing basic wound care. I took care of a gentleman who was a quadriplegic."

Wisconsin, like 20 other states, overrides the federal exemption on minimum wage. Even so, Dudzinski says the highest wage at her agency is less than $11 an hour, and starting pay has gone down in recent years.

"In a typical supply-demand situation, if demand is greater than supply, then wage rates would rise to clear the market," says Dorie Seavey of the Paraprofessional Healthcare Institute. But she says supply and demand don't really work when it comes to home care aides.

"One of the biggest things that their wage rates are tied to are public reimbursement rates," she says. Namely, Medicaid, and a number of states have been cutting that to balance budgets. But Seavey says paying less to home aides doesn't necessarily save public money. About half of home care workers are in households so poor that they themselves rely on public benefits, like food stamps and Medicaid.

Even in privately paid home care, there is pressure to keep wages low.

"There's a fine line between what seniors are willing to pay for our services before they opt for other alternatives," says Paul Hogan, who heads Home Instead, one of the largest national home-care agencies. The company starts workers at $9 an hour, though charges clients at least twice that. Hogan says a higher rate could push seniors to hire someone outside an agency.

"It leaves the senior much more exposed to risk, such as fraud and abuse," he says. Worker advocates contend such fears are overblown.

Home Instead has lobbied especially hard to keep the labor exemption on overtime. Hogan says many aides log long shifts spending the night with clients.

"If the overtime would apply to these situations it would drive clients' bills up 20 or 30 percent," he says, "and this just makes it out of reach for them."

Advocates counter that, though it might be more more complicated, clients can avoid overtime by using extra aides to trade off night shifts. A recent study also finds that home health care is one of the most profitable franchises in the country, and growing fast.

Demand is set to soar, with polls showing that baby boomers overwhelmingly want to age in their own home. The hope is that enough people will want the job of caring for them there.

This story was produced for broadcast by Marisa Penaloza.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

ROBERT SIEGEL, HOST:

As baby boomers age, there is more need for home health care workers to take care of them. That workforce is one of the country's fastest growing but it's also one of the lowest paid. Turnover is high, and there are fears of a labor shortage. NPR's Jennifer Ludden has this story on efforts to make the job more attractive.

JENNIFER LUDDEN, BYLINE: In a Bronx high-rise, two dozen women are training to be home care workers. On one side, a student pretends to be a bedridden client while another gently stretches her limbs.

MARIA SOTO: Separate the leg, holding it the same way.

LUDDEN: Assistant trainer Maria Soto coaches them through it.

SOTO: Roll it in. Roll it out. OK.

LUDDEN: This extensive, month-long program distinguishes Cooperative Home Care Associates, along with the vision of the agency's President, Michael Elsas.

MICHAEL ELSAS: We think that our workers are ready to use some of the newer technology, you know, the smartphone type of technology.

LUDDEN: He says they could monitor and record things, like changes in a patient's skin color, cutting down on doctor's visits, even hospitalizations.

ELSAS: Which would lower the cost of healthcare, have a dramatic effect on the cost of healthcare.

LUDDEN: And which Elsas hopes would have a dramatic effect on how much society values home health workers. Right now, many get no training at all. And with a median wage under $10 an hour, it's hard to call this a career. Cooperative trainee Mary Miranda will earn even less than she did in retail.

MARY MIRANDA: It's not much, but like I said, it's a stepping stone. Sometimes you got to just take it as it goes and make the best out of everything.

LUDDEN: Advocates say one big problem is a decades-old law that exempts home care workers from federal minimum wage and overtime, likening them to babysitters. Elsas says this drags down wages across the field. A year ago, President Obama proposed a rule to end the exemption, but that's on hold.

UNIDENTIFIED WOMAN: On three - one, two, three...

UNIDENTIFIED GROUP: DCA.

UNIDENTIFIED WOMAN: And again...

LUDDEN: A few weeks ago, the Direct Care Alliance sponsored a Washington, D.C. lobbying day. Several dozen home aides posed for a photo, then headed to Capitol Hill to make their case for better pay. Tracy Dudzinski had traveled from Wisconsin.

TRACY DUDZINSKI: When I'm in home care, I'm a doctor. I'm a nurse. I'm a cook. I'm a dietician. You name it, we do it.

LUDDEN: Over 16 years, Dudzinski says she's seen her duties grow more complex as people live longer and hospitals release patients sooner after surgery.

DUDZINSKI: We have to watch for if they're having a reaction to medication. Sometimes we're doing some basic wound care. I took care of a gentleman who was a quadriplegic.

LUDDEN: Wisconsin, like 20 other states, overrides the federal exemption on minimum wage, but Dudzinski says the highest wage at her agency is still under $11 an hour and starting pay has been going down.

DORIE SEAVEY: In a typical supply/demand situation, if demand is greater than supply, then wage rates would rise to clear the market.

LUDDEN: But supply and demand don't really work when it comes to home care aides, says Dorie Seavey of the Paraprofessional Health Care Institute.

SEAVEY: One of the biggest things that their wage rates are tied to are public reimbursement rates.

LUDDEN: Namely, Medicaid. And a number of states have been cutting that to balance budgets. But Seavey says paying less to home aides doesn't necessarily save public money. About half of home care workers are in households so poor they themselves rely on public benefits, like food stamps and Medicaid. Even in privately paid home care, there's pressure to keep wages low.

PAUL HOGAN: There's a fine line between what seniors are willing to pay for our services before they opt for other alternatives.

LUDDEN: Paul Hogan heads Home Instead. The national home care agency starts workers at $9 an hour, though charges clients at least twice that. Hogan says a higher rate could push seniors to hire someone outside an agency.

HOGAN: It leaves the senior much more exposed to risk such as fraud and abuse.

LUDDEN: Worker advocates say such fears are overblown. Home Instead has lobbied especially hard to keep the labor exemption on overtime. Hogan says many aides log long shifts spending the night with clients.

HOGAN: If the overtime would apply to these situations, it would drive some clients' bills up by, you know, 20 to 30 percent. And this just makes it out of reach for them.

LUDDEN: But advocates say clients can avoid overtime by using two aides to trade off night shifts. A recent study also finds home health care is one of the most profitable franchises in the country and growing fast.

UNIDENTIFIED WOMAN #2: I fill in for tomorrow, Thursday and Friday, correct?

LUDDEN: Back at Cooperative Home Care Associates, a room full of schedulers work to match clients with aides.

(SOUNDBITE OF PHONE RINGING)

LUDDEN: Demand is set to soar with baby boomers overwhelmingly wanting to age in their own home. The hope is that enough people will want the job of caring for them. Jennifer Ludden, NPR News.